中华创伤骨科杂志
中華創傷骨科雜誌
중화창상골과잡지
CHINESE JOURNAL OF ORTHOPAEDIC TRAUMA
2012年
7期
571-576
,共6页
陈安富%余斌%姜楠%董福%覃承诃
陳安富%餘斌%薑楠%董福%覃承訶
진안부%여빈%강남%동복%담승가
胫骨骨折%骨钉%骨板%Meta分析
脛骨骨摺%骨釘%骨闆%Meta分析
경골골절%골정%골판%Meta분석
Tibial fractures%Bone nails%Bone plates%Meta-analysis
目的 对髓内钉与钢板治疗成人胫骨干远端骨折的相关并发症、进行Meta分析,为胚骨干远端骨折的治疗提供参考依据.方法 计算机检索MEDLINE (1966年至2012年3月)、EMbase(1974年至2012年3月)、Cochrane图书馆及中国生物医学文献数据库(1979年至2012年3月),手工检索相关的中、英文骨科杂志.收集髓内钉与钢板治疗成人胫骨干远端骨折的随机对照研究(RCT)和半随机对照研究(CCT),选择总体并发症发生率、感染发生率、骨折畸形愈合发生率、骨折不愈合发生率、骨折延迟愈合发生率、二次手术率作为Meta分析的评价指标,按Cochrane协作网推荐的方法进行系统评价.结果 共纳入7个研究463例患者,其中RCTs 3个、CCTs 4个；髓内钉组258例,钢板组205例.Meta分析结果显示:髓内钉组畸形愈合率明显高于钢板组,差异有统计学意义[RR=3.81,95％ CI(2.01,7.21).P＜0.05)；两组总体并发症发生率[RR=1.46,95％ CI(0.90,2.38),P=0.12]、感染发生率[RR =0.54,95％ CI(0.27,1.07),P=0.08]、骨折不愈合发生率[RR=1.74,95％ CI(0.62,4.90),P=0.30]、骨折延迟愈合发生率[RR=2.03,95％ CI(0.56,7.31),P=0.28]、二次手术率[RR=1.22,95％ CI (0.71,2.10),P=0.47]比较差异均无统计学意义.结论 对于成人胫骨干远端骨折,与钢板治疗相比,髓内钉治疗增加骨折畸形愈合率,钢板可能更适合治疗成人胫骨干远端骨折.
目的 對髓內釘與鋼闆治療成人脛骨榦遠耑骨摺的相關併髮癥、進行Meta分析,為胚骨榦遠耑骨摺的治療提供參攷依據.方法 計算機檢索MEDLINE (1966年至2012年3月)、EMbase(1974年至2012年3月)、Cochrane圖書館及中國生物醫學文獻數據庫(1979年至2012年3月),手工檢索相關的中、英文骨科雜誌.收集髓內釘與鋼闆治療成人脛骨榦遠耑骨摺的隨機對照研究(RCT)和半隨機對照研究(CCT),選擇總體併髮癥髮生率、感染髮生率、骨摺畸形愈閤髮生率、骨摺不愈閤髮生率、骨摺延遲愈閤髮生率、二次手術率作為Meta分析的評價指標,按Cochrane協作網推薦的方法進行繫統評價.結果 共納入7箇研究463例患者,其中RCTs 3箇、CCTs 4箇；髓內釘組258例,鋼闆組205例.Meta分析結果顯示:髓內釘組畸形愈閤率明顯高于鋼闆組,差異有統計學意義[RR=3.81,95％ CI(2.01,7.21).P＜0.05)；兩組總體併髮癥髮生率[RR=1.46,95％ CI(0.90,2.38),P=0.12]、感染髮生率[RR =0.54,95％ CI(0.27,1.07),P=0.08]、骨摺不愈閤髮生率[RR=1.74,95％ CI(0.62,4.90),P=0.30]、骨摺延遲愈閤髮生率[RR=2.03,95％ CI(0.56,7.31),P=0.28]、二次手術率[RR=1.22,95％ CI (0.71,2.10),P=0.47]比較差異均無統計學意義.結論 對于成人脛骨榦遠耑骨摺,與鋼闆治療相比,髓內釘治療增加骨摺畸形愈閤率,鋼闆可能更適閤治療成人脛骨榦遠耑骨摺.
목적 대수내정여강판치료성인경골간원단골절적상관병발증、진행Meta분석,위배골간원단골절적치료제공삼고의거.방법 계산궤검색MEDLINE (1966년지2012년3월)、EMbase(1974년지2012년3월)、Cochrane도서관급중국생물의학문헌수거고(1979년지2012년3월),수공검색상관적중、영문골과잡지.수집수내정여강판치료성인경골간원단골절적수궤대조연구(RCT)화반수궤대조연구(CCT),선택총체병발증발생솔、감염발생솔、골절기형유합발생솔、골절불유합발생솔、골절연지유합발생솔、이차수술솔작위Meta분석적평개지표,안Cochrane협작망추천적방법진행계통평개.결과 공납입7개연구463례환자,기중RCTs 3개、CCTs 4개；수내정조258례,강판조205례.Meta분석결과현시:수내정조기형유합솔명현고우강판조,차이유통계학의의[RR=3.81,95％ CI(2.01,7.21).P＜0.05)；량조총체병발증발생솔[RR=1.46,95％ CI(0.90,2.38),P=0.12]、감염발생솔[RR =0.54,95％ CI(0.27,1.07),P=0.08]、골절불유합발생솔[RR=1.74,95％ CI(0.62,4.90),P=0.30]、골절연지유합발생솔[RR=2.03,95％ CI(0.56,7.31),P=0.28]、이차수술솔[RR=1.22,95％ CI (0.71,2.10),P=0.47]비교차이균무통계학의의.결론 대우성인경골간원단골절,여강판치료상비,수내정치료증가골절기형유합솔,강판가능경괄합치료성인경골간원단골절.
Objective To systematically compare the related complications of distal tibial shaft fractures in adults treated by intramedullary nails and plates.Methods According to the methods of systematic review of Cochrane,we searched for articles comparing intramedullary nail and plate for distal tibial shaft fractures in adults in MEDLINE (from 1966 to March 2012),EMbase databases (from 1974 to March2012),Cochrane library,CBM discs (from 1979 to March 2012) and the relevant Chinese and English orthopedic journals.All randomized controlled trials (RCTs) and controlled clinical trials (CCTs) were included for the present study.The total complications,infections,malunion,nonunion,delayed union and secondary operation were chosen as evaluation indexes for the present Meta-analysis.The system review was performed using the method recommended by the Cochrane Collaboration.Results Three RCTs and 4 CCTs with a total of 463 patients were included (258 in the intramedullary nail group and 205 in the plate group).Compared with the plate treatment,intramedullary nail significantly increased the risk of malunion[RR =3.81,95％ CI(2.01,7.21 ),P ＜ 0.05].There were no statistically significant differences regarding total complications[RR =1.46,95％ CI(0.90,2.38),P =0.12],infection[RR =0.54,95％ CI(0.27,1.07),P =0.08],nonunion[RR=1.74,95％CI(0.62,4.90),P=0.30],delayed union[RR=2.03,95％CI (0.56,7.31),P =0.28]and secondary operation[RR =1.22,95％ CI(0.71,2.10),P =0.47]between the 2 groups.Conclusion Since intramedullary nail may significantly increase the risk of malunion,the plate may be a better choice for distal tibial shaft fractures in adults.
